Nursing without walls—delivering quality care to populations how, when and where they need, and caring for their unique needs without traditional encumbrances—has become the essence of nursing that is practiced, taught and studied at the UAB School of Nursing.
The strategic alignment with UAB’s premier academic medical center, as well as with other partners, has helped make the School an internationally recognized leader in building knowledge, access and capacity, as well as in producing leaders who shape coordinated, proactive and superior patient care.
Key to the nursing without walls concept in the School is its focus on population-based care—targeting specific populations of people and then developing, implementing and evaluating interventions to improve the health of that population with innovation and efficiency consistent with seamless care across the continuum.
Creating programs to better care for Veterans, taking nursing care to underserved communities through nurse-managed clinics and telehealth, establishing policy to influence nursing practice, creating more accessible health information to heighten individuals’ quality of life or their understanding of their health, giving undergraduate students community-based research opportunities… all are unencumbered by traditional silos and encompass “Nursing Without Walls” and population-based care, and are the future of health care.
And who better to lead health care into the future and everything these concepts embody than nurses—the only profession practicing every virtue these hold dear—healing, supporting, listening, discovering and teaching.
A lengthy residency program has long been the standard rite of passage for medical school graduates prior to entering clinical practice. In contrast, nurses have traditionally left school and gone straight to work in a clinical setting. But in recent years, growing numbers of nursing schools and hospitals have partnered to offer nurse practitioner residency programs, allowing newly trained nurse practitioners to experience the mentoring and additional training that come with an environment blending on-the-job experience with an educational setting.
Unique residency, unequaled value
The UAB School of Nursing has started a new graduate residency in partnership with the Birmingham Veterans Affairs Medical Center for mental health nurse practitioners. It is designed to put more nurse practitioners into the VA pipeline to address the mental health needs of a growing Veteran population.
One of only four sites in the country to receive VA funding for a Mental Health Nurse Practitioner Residency Program, UAB launched its program in fall 2013 with a full complement of three residents. The program offers a 12-month paid residency within the Birmingham VAMC for recent nurse practitioner graduates who have already passed their national certification exams.
With the new mental health nurse practitioner residency at the Birmingham VAMC and the recent award of the VANAP-GE (see sidebar, p.9), UAB is providing a range of opportunities for recent nurse practitioner graduates to continue their training in a paid professional setting, preparing them for future success on the job, offering a pathway to the DNP degree and improving care for the patients they will go on to serve.
Growth of Graduate Residency Programs
The Affordable Care Act places great importance on health care teams, and providing residency programs for nurses supports that value, said Doreen C. Harper, PhD, RN, FAAN, Dean and Fay B. Ireland Endowed Chair in the UAB School of Nursing. For instance, nurse practitioner residents work closely with pharmacists, board-certified physicians and other nurses and nurse practitioners, learning the value of the team approach to health care and their roles as team members.“
Nurse practitioner residencies are becoming more common because of the complexity of care, particularly with the growing number of people with chronic illnesses and multiple co-morbidities,” said Teena McGuinness, PhD, RN, FAAN, Co-Director of the Mental Health Nurse Practitioner Residency Program. “Advanced practice nurses will be called upon to assume leadership roles and to lead health care teams. A residency allows them to be immersed in teams for a year and see how it all works.”
Nurse practitioner residency programs also help ease the transition for new nurse practitioners from the classroom to the clinical setting while offering a platform for leadership and expert practice through DNP preparation. Across the country, graduate nurse practitioner residency programs are becoming a sought-after way for nurses to start their careers in rich learning environments with ongoing support from both clinicians and faculty members. “These programs allow nurses not to just be thrown into the complexity of their jobs, but to receive a significant amount of mentoring, training and professional socialization,” McGuinness said.
Mental Health Nurse Practitioner Residency
UAB’s selection as one of the four sites for a Veterans Health Administration-sponsored residency for mental health nurse practitioners allows the UAB School of Nursing to expand a longtime partnership with the Birmingham VAMC and to better prepare nurse practitioners to meet the challenging psychological needs of America’s Veterans.
“UAB loves America’s Veterans,” McGuinness said. “We really have a heart for all Veterans, and because some Veterans have some very complex mental health and chronic care issues, this program allows us to prepare nurse practitioners to uniquely serve their health needs.”
The School of Nursing’s ongoing partnership with the Birmingham VAMC played a role in the site’s selection, said Cynthia Selleck, PhD, RN, FNP, the School’s Associate Dean for Clinical and Global Partnerships. Since 2008, the two institutions have worked together on several key projects, including the VA Nursing Academy Partnership, which teams VA Medical Centers with accredited schools of nursing with the goal of providing compassionate, highly educated nurses to meet the health care needs of America’s heroes.
The Mental Health Nurse Practitioner Residency Program, created by a three-year pilot grant from the Veterans Health Administration Office of Academic Affiliation to the Birmingham VAMC, “allows smooth assimilation to the nurse practitioner role,” McGuinness said. “New nurse practitioners can improve skills and development while being mentored by experienced mental health nurse practitioners, psychiatrists, and other mental health providers, which is similar to the role of the one-year required physician psychiatry residency.”
The program gives residents the opportunity to rotate through nine specialty areas, including programs for post-traumatic stress disorder, substance abuse recovery, and a team that works with seriously mentally ill Veterans in the community, McGuinness said. In addition to working full-time in a clinical mental health setting, residents spend time in classrooms twice weekly with psychiatry physician residents and psychology interns and meet weekly with program directors for ongoing support.
“Residents get to see how mental health care teams work, and decide whether they want to commit to a career at the VA,” McGuinness said. “When they complete the residency they can hit the ground running or as part of the residency enter the DNP program.”
Not only does the residency program boost the confidence of mental health nurse practitioners and prepare them to transition to permanent employment as experienced professionals, but it also increases awareness of the nurse practitioner role to all professionals in the hospital setting. “Many health care providers, including other mental health disciplines, are not familiar with and do not fully understand the role of mental health nurse practitioners,” McGuinness said. “This program allows for mentoring from dedicated clinicians who have interest in, patience with, and understanding of the mental health nurse practitioner role.”
The mental health nurse practitioner residency program is also important to the Veteran community as well as the health care community. Because many Veterans have a wide range of mental health needs, the program offers mental health nurse practitioners an opportunity to learn how to serve patients with a variety of needs. And part of the residency involves education about the various cultures of each era of Veterans. “World War II Veterans had a completely different experience from Vietnam Veterans,” McGuinness said. “We spend a lot of time on military culture and embrace all eras of military service so residents know how to care for each Veteran.”
